Category Archives: Health Care

COVID-19 Update: Blastoff!

According to data published by the Virginia Department of Health (VDH) this morning, the number of new COVID-19 cases confirmed in Virginia Friday shot up to 395, up from 306 the previous day, bringing the total number of confirmed cases to 2,407. To emphasize the change in the number of new cases, I have changed the graph I update daily from displaying total cases to new cases.

Here’s the daily data roundup:

Total COVID-19 cases: 2,407, up 395 from the previous day.
Total hospitalizations: 390, up 68.
Total deaths: 52, up six.
Total tests: 21,547, up 2,547.
Percentage tests positive: 15.5%

And here, straight from the spreadsheet of John Butcher, are the current “doubling” rates for key metrics:

Case count: 3.4 days
Hospitalizations: 3.7 days
Deaths: 3.1 days

— JAB

Thank God for Medicaid Expansion

By Peter Galuszka

For years after the Affordable Care Act, “Obamacare,” made millions of federal dollars available for states to expand Medicaid health coverage, Virginia Republicans steadfastly blocked Virginia from using the money.

Led by former House Speaker Bill Howell and Sen. Tommy Norment, the GOP claimed that expanding Medicaid to nearly 400,000 people would be too expensive and would blow out state funding.

This skinflint approach was finally put to rest after Democrat Ralph Northam became governor in 2018, foreshadowing a Democratic sweep of the General Assembly in elections last year.

Thank God the Democrats prevailed.

Virginia’s formerly robust economy has been shattered by the COVID 19 pandemic. Last week, some 110,000 Virginians filed for unemployment support. It was 46,277 the week before.

Who covers them is an open question but many would qualify for Medicaid. Expansion has boosted lower-income Virginians so that they may be able to better ride out the pandemic. Continue reading

Percent of Positive COVID-19 Tests on Upward Trend

Ask and ye shall receive. In the comments section of a recent post, Don Rippert makes an interesting observation: “The cue for a serious outbreak seems to be a rise in percent positive for those being tested. That’s why Michigan and Indiana are being watched closely right now. As I recall from the article I read once the positive percentage hits about 15% you can be assured that the sh** is about to hit the fan.”

What, then, is the trend in here in Virginia? The percentage of positive tests is running steadily higher, surpassing 15% at least twice in the past four days of data. If Don’s rule of thumb is correct, we’re near the point where the fecal matter soon will strike the rapidly revolving blade.

Any conclusion comes with caveats, mainly pertaining to the quality and consistency of the data. However, holding all other things were equal, one would expect the percentage of positives should be heading down. With access to very few tests early on, medical practitioners hewed to strict testing protocols. Only patients with symptoms most closely matching those of COVID-19 were tested. One would expect a high rate of hits. As testing kits become more readily available, they began administering somewhat more broadly — targeting front-line healthcare workers, even those who don’t show symptoms.

Duck, you  may not like what’s coming. — JAB

COVID-19 Update: Hospitalizations, Deaths Mount


Today’s data update from the Virginia Department of Health shows an an accelerating increase in confirmed new COVID-19 cases, hospitalizations, and deaths yesterday.

Total COVID-19 cases: 2,012, up 306 over the previous day. The previously highest daily increase was 239.
Total hospitalizations: 312, up 66 from the previous day. The previously highest daily increase was 38.
Total deaths: 46, up five from the previous day.

And here are John Butcher’s latest calculations for the “doubling” rate for key metrics:

COVID-19 confirmed cases: 3.3 days
Hospitalizations: 3.7 days
Deaths: 3.0 days

The doubling rates have been holding steady for the past few days. There is no sign at the moment that the epidemic curve is flattening. If the current rate of increase holds, the number of COVID-19 hospitalizations will hit 10,000 in about 18 days, inundating Virginia’s healthcare system.

— JAB

Virginia Shortchanged by National Stockpile? Don’t Complain, Do Something

Source: House Committee on Oversight and Reform

by James A. Bacon

Virginia has received only a fraction of the medical supplies from the Strategic National Stockpile it needs to fight the COVID-19 virus, according to documents released by the House Committee on Oversight and reform.

“The new documents we are releasing today confirm the urgent warnings we have been hearing from our nation’s governors and health care professionals for weeks — they do not have enough personal protective equipment and medical supplies, and the Administration has provided only a tiny fraction of what they desperately need,” stated Rep. Carolyn B. Mahoney, chairwoman of the committee.

“While we appreciate what we’ve received from the national stockpile, it isn’t close to enough,” Governor Ralph Northam said in a statement to the Virginia Mercury Thursday. “Virginia’s health care providers and first responders deserve basic protection, equipment and supplies. We need more, period. Virginia will continue to exhaust every option — including federal support — to get what we need on the front lines.”

As of Tuesday, the Virginia Department of Health had a total of only 78,920 N95 respirator masks available for distribution from the state stockpile, the Mercury reported, based on data obtained through a Freedom of Information Act request. Thirteen Virginia hospitals have indicated that they would have difficulty obtaining or replenishing enough personal protective equipment (PPE) to meet demand within the next three days without assistance. Continue reading

Latest COVID-19 Job Toll: 112,000 in Virginia Last Week

by James A. Bacon

The latest unemployment claims are in, and they’re brutal — more than twice the level in Virginia (and across the country) of last week, which was, by far, the worst week in the history of the United States. For the week ending March 28, the number of seasonably unadjusted initial claims was 112,497 — up from 46,277 the previous week.

The map from the Virginia Employment Commission website above shows the geographic distribution of unemployment claims. In raw numbers, the layoffs look worse in Virginia’s major metropolitan regions — Northern Virginia, Richmond, and Hampton Roads. But it’s no surprise that the number of job losses will be highest in the most populous parts of the state. What the maps do not show is the job losses expressed as a percentage of the workforce. In that light, the jobs claims in the western part of Virginia (basically Lynchburg west) look dreadful.

The Federal Reserve Bank of Richmond has been surveying employers in the Fifth Federal Reserve district, which includes Virginia, since late February. The questionnaires asked how the spread of COVID-19 has impacted businesses, and how the businesses expected the virus to impact operations. Both questions show a marked deterioration in expectations between Feb. 27 and March 18. Continue reading

Help Is Available, Governor

Dr. Jay Schnitzer, chief medical officer of Virginia-based MITRE, is a national leader in the COVID-19 response. Could he help Virginia?

by James C. Sherlock

The issues I spotlighted yesterday in Governor Northam’s news conference are not a Democrat or a Republican thing. They just need to be fixed. If you or I were elected Governor, we would consider our new responsibilities.  We would find that we have basically four:

  • Appoint competent and hard-working cabinet and sub-cabinet people and give then the authority to do their jobs. A corollary is that we would not suffer fools once we saw them in action.
  • Produce a budget.
  • Declare state emergencies, which activate the extraordinary crisis authorities granted to us under state law.
  • Use those authorities to lead and manage the state.

We would do first things first, and ensure a competent administration. We would see that we don’t have to produce a budget for a year.

Then we would turn to the last two. Governors come to the job with a near infinite variety of skills and experience. Most don’t have any experience in state-level crisis management. We would see that we could not delegate such responsibilities and make sure that we were ready. We would have our state department of emergency management train us in the basic tools of crisis management, the National Response Plan and the National Incident Management and the state annexes to both. We would ask those same offices to schedule training and exercises in the federally pre-scripted and funded scenarios for such crises: Continue reading

More COVID-19 Innovators and Heroes

Intubation box. Photo credit: Dr. Hsien Yung Lai by way of Virginia Business.

From Taiwan with love. Dr. Scott Hickey, president of the Virginia College of Emergency Physicians, is contracting with two Powhatan County companies to produce boxes designed to protect emergency health care workers while they intubate patients with COVID-19. Designed by a doctor in Taiwan, the protective box is being replicated in the U.S. to shield doctors from droplets that can spread the disease. The builders are selling the boxes at cost for $270. They can be cleaned with bleach or alcohol.

Hickey explains the necessity of the boxes to Virginia Business. Physicians’ highest-risk exposure to patients — oral secretions, nasal secretions, eye secretions — is when they have to put them on a ventilator or intubate them. The box doesn’t provide total protection, but it does create an extra layer of defense. The box is not commercially available anywhere in the world. Hickey made a prototype and reached out to friends of his, who responded immediately. Now a major insurance carrier is interested in providing  the boxes for emergency rooms across Virginia.

Sheetz sandwiches for kidz. Sheetz Inc., a Pennsylvania-based operator of gas stations and convenience stores, will start providing fee lunches for children in need at 21 Virginia locations starting Thursday. The “Kidz Meal Bagz” program will include a turkey sandwich, chips and a drink, reports Virginia Business. Families can go to participating stores and ask an employee at the register for a meal. They’ll be offered one bag per child.

Newspaper subsidies for small business. Ogden Newspapers, the parent company of the Loudoun Times-Mirror, has established a $1 million fund to help local businesses get back to full strength by subsidizing local marketing through matching grants, reports the Times-Mirror. Businesses in the Loudoun market can apply for grants up to $15,000. The fund is open to all locally owned businesses impacted by the coronavirus. Grants can be used for print and online advertising in the Times-Mirror and LoudounTimes.com.

— JAB

COVID-19 Update: Mounting Toll

Here’s the latest COVID-19 data from the Virginia Department of Health based on yesterday’s developments.

Total cases: 1,706, up 222 yesterday.
Total hospitalizations: 246, up 38 yesterday.
Total deaths: 41, up 7 yesterday.
Total tests: 17,589, up 2,245 yesterday.

And here, straight from Cranky’s Excel spreadsheet to you, the updated “doubling” time for key metrics:

Case count: 3.3 days
Hospitalizations: 3.7 days
Deaths: 2.9 days

Finally, we have a social justice alert! I can’t believe the racial bean counters haven’t seized on this yet. Here is the VDH breakdown of COVID-19 cases by race: Continue reading

Twin Tragedies: COVID-19 and the Northam Administration

by James C. Sherlock

Communication in this time of crisis has not been a notable strength of either Governor Ralph Northam or his cabinet. I discovered the reason why in the Governor’s press conference today: They are clueless.

The Northam administration’s online communications

The state’s official website as of today has no information about the real time activities of emergency management, about testing availability, about personal protective equipment, or about anything else that matters.

  • As for the Virginia Department of Health (VDH), the last entry on the Health Commissioner’s Blog is dated October 15, 2018.
  • Not a single entry in the media room discusses what the state is actually doing, only what they see happening.
  • Not a word about the functioning of Virginia’s six Health Care Coalitions (HCCs).

No word either about the actions of Virginia’s Emergency Operations Center (VEOC), just that the center is conducting response operations. The situation report tells us nothing about what state officials are doing, how they are doing it or what success they may or may not be having.

The Governor’s April 1 Press Conference

Now for today’s Governor’s press conference. I must report that I am literally stunned. Continue reading

Localities Are Re-Writing Budgets. So Should the State.

by James A. Bacon

It is obvious to some people that COVID-19’s body blow to the economy will have a devastating impact on state/local government finances. Old Dominion University professors Ron Carlee and Robert McNab have estimated that local governments in Hampton Roads are losing at least $16 million a month in local taxes, while local governments across the state are losing $60 million monthly or more. And the blood-letting is getting worse.

Hotel occupancy and revenues were only 80% of normal levels in early March. By the end of the month, the estimate, revenues were running only 20%. Sales, business-license, hotel & motel, restaurant & food taxes comprise a “vulnerable” category of local government revenue amounting to $637 million in Hampton Roads and $2.9 billion statewide.

Unlike the federal government, the professors write, state and local governments must balance their budgets (unless, I might add, they engage in hidden deficit spending like running up unfunded pension liabilities and falling behind in building and infrastructure maintenance). “It’s not time to panic,” they write in the Richmond Times-Dispatch, “it’s time to prepare.”

Some local governments are acting proactively. Fairfax County and Chesterfield County are among those slashing budgets — including next year’s — in anticipation of declining revenues. Remarkably, Chesterfield is anticipating a decline in revenue sources funneled through the state even though Governor Northam and General Assembly budget writers have yet to re-work the budget passed earlier this year before the full dimensions of the COVID-19 crisis were apparent. Continue reading

Bacon Bits: Mobilizing Against COVID-19

NoVa field hospital sites identified. State officials have begun identifying sites to use for field hospitals in the event that an influx of COVID-19 patients overwhelm the capacity of Northern Virginia’s hospitals. The first phases of plans call for adding beds in existing hospitals or on hospital campuses. A third phase would establish new treatment facilities at the National Conference Center in Loudoun County, the Dulles Expo Center in Fairfax County, and the Goerge Mason University campus in the City of Fairfax, according to a briefing given yesterday to the Prince William County Board of Supervisors, as reported by WTOP News. The Northam administration has said it was examining sites with the Army Corps of Engineers, but had not publicly identified specific locations.

Thousands volunteer for medical reserve corps. Virginians can erect emergency field hospitals, but who will staff them? Health providers will be stretched to the breaking point just dealing with COVID-19 patients in regular hospitals. Perhaps members of the Virginia Medical Reserve Corps can helo. As of Tuesday morning, reports the Richmond Times-Dispatch, more than 12,300 volunteers across a variety of health professions had signed up. Of those about 8,200 are deployable, meaning they have had their credentials confirmed. Virginia’s Medical Reserve Corps, established in 2002 after 9/11, operates 27 units across the state.

Making more hand sanitizer. The Appalachian College of Pharmacy, located in Buchanan County, is using its compounding lab to produce hand sanitizer. The college delivered its first shipment last week to Food City for distribution to Food City pharmacies, reports the Bluefield Daily Telegraph. “We told them we’ll take all you can make,” said Food City CEO Steve Smith. “We’ve been out of hand sanitizer for days and have tried different avenues to get it without success.” (Hat tip: Mary Trigiani.)

Federal and State Responses to COVID-19

Duck and cover!

by James C. Sherlock

The federal government’s relationships with state and local governments is defined by the U.S. Constitution. Presidential management of internal national crises is constrained by lack of command authority over the states. No governor works for the President. He cannot order them to do anything, even in wartime. He can take control of industries, but not state governments. If the President nationalizes the National Guard, the Guard loses its ability to enforce state laws or respond to the Governor. And no, I don’t think we need to change our constitution.

The most complete restructuring of the federal government in my lifetime was the creation of the Department of Homeland Security after 9/11 and a complete rewrite of the National Response Plan. Giving birth to that full-grown mastodon was as noisy and bloody as you can imagine. After its birth, it was very awkward for a time. FEMA, now an element of DHS, existed at 9/11 exclusively as an agency that wrote checks upon the Presidential implementation of the Stafford Act. Although all of the plans and programs were restructured in 2002 and 2003, FEMA had that same role when Katrina happened in 2005.

After Katrina, the National Response Plan (NRP) was re-written again. The lessons learned from that tragedy resulted in a major restructuring of FEMA to support a national emergency command center and greatly improve its logistics capabilities, but those logistics capabilities still largely lie with check writing to implement contracts negotiated both before and during crises. Virtually every other major federal agency has a role in federal response coordinated by FEMA with participation of other federal agencies defined in plans specific to the type of emergency. The White House has its own staff to support the president and direct the federal agencies. Continue reading

COVID-19 Update: Hospitalizations Surge

Wrong reaction, lady, your hands should not be touching your face!

The Virginia Department of Health has updated its statistics to reflect yesterday’s numbers. The big movers: hospitalizations and deaths, both of which surged 26%.

Total confirmed COVID-19 cases: 1,484, up 234
Total hospitalizations: 208, up 43
Total deaths: 34, up 7
Total tests: 15,344, up 1,943

Here are John Butcher’s latest calculations for the “doubling” rate for key metrics:

Confirmed cases: 3.2 days
Hospitalizations: 3.7 days
Deaths; 2.9 days

The hopeful news is that the doubling rate for hospitalizations shows signs of stretching out. It makes a substantial difference if it takes 3.7 days for hospitalizations to double compared to 3.0 days. A top public health challenge is to “flatten the curve” — to prevent Virginia hospitals from getting overwhelmed with COVID-19 patients at one time.

I question, however, how well the VDH data reflects the reality in hospital wards and emergency rooms. Bon Secours Mercy Health, which operates 11 hospitals in the Richmond and Hampton Roads regions, announced yesterday that it has furloughed 700 full-time employees across seven states and 12 markets, reports Virginia Business. Continue reading

Wanted: Government Informants

by Kerry Dougherty

Nosy neighbors and tattletales.

They’ve been with us always. And they’ve always been despicable.

When I was a kid a reclusive neighbor – we’ll call her Mrs. Murphy – spent all of her time peering out of her windows. If a kid so much as planted a bare toe on the Murphy lawn her front door swung open and she threatened to call your mother.

Once, when a stray cat had been run over by a car, we kids decided to stage a funeral and bury it in an overgrown vacant lot next to her house.

Old Lady Murphy saw us and called the cops.

Er, cop. We had only one officer in our small town.

Barney Fife arrived in minutes and demanded to know what we were doing.

Once we explained he seemed inclined to let us proceed until Mrs. Murphy roared out, red-faced, with rollers in her hair, hollering that she could smell the dead animal and it was a health hazard. Continue reading